=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568459634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH ALLEN BEIL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2005
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2852 GRIMES RANCH RD
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78732-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-640-4141
-----------------------------------------------------
Fax | 877-787-4712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30283
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78755-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-640-4141
-----------------------------------------------------
Fax | 877-787-4712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | K3681
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------